Infected pseudoaneurysm caused by suture-mediated vascular closure after ablation of atrial fibrillation: A case report.

Abstract

Introduction: Suture-mediated vascular closure devices have been widely used in catheter ablation, with 0.14-0.3 % incidence of pseudoaneurysm complications. Here, we report the only case at our institution to date of an infectious pseudoaneurysm caused by a suture-mediated vascular closure device following catheter ablation.

Presentation of case: An 80-year-old man developed a fever 7 days after an atrial fibrillation ablation procedure, using a suture-mediated vascular closure device. Blood cultures revealed the presence of Staphylococcus aureus. Subsequently, a rapidly enlarging mass appeared in the right thigh on the 14th postoperative day.

Discussion: Computed tomography was suggestive of a pseudoaneurysm, and surgical repair was performed. The mass was incised under balloon expansion at the right common femoral artery, and intraoperative findings confirmed the perforation of the femoral artery and adhesion of the infected tissue, necessitating vascular repair and debridement of the infected area. In our institution's experience, the incidence rate of infectious pseudoaneurysms after the use of vascular closure devices is extremely low at 0.04 %.

Conclusion: Although local infections associated with suturing devices are exceedingly rare, prompt intervention is essential when they occur. This report raises awareness of the importance of diagnosing and managing infected pseudoaneurysms, a complication following catheter ablation, as the onset of the condition occurs with a time lag compared to systemic symptoms.